Management of glenohumeral osteoarthritis in the younger patient: A population level analysis of usual care delivery in a large health system

Objective: To characterize healthcare utilization in a younger population with glenohumeral osteoarthritis. Methods: Adults seeking care for glenohumeral osteoarthritis between July 2013 and March 2019 were analyzed. Ambulatory visits, pharmacological, and non-pharmacological treatment, and surgical and radiological procedures, were compared by active-duty status and sex. The association between exercise therapy receipt and subsequent surgery was modeled using an adjusted logistic regression, reporting adjusted odds ratios (OR). Results: There were 21,369 individuals (29.4 ​% female; mean age 50.3 [standard deviation (SD) 9.9] years), with 24.1 ​% military patients. The mean number of ambulatory shoulder visits per patient was 9.4 (SD 12.5). For pharmacological care 26.2 ​% received an injection, 14.8 ​% received non-steroidal anti-inflammatory drugs, 13.4 ​% opioids, 11.8 ​% muscle relaxants, and 9.9 ​% other analgesics. Non-pharmacological care included 44.5 ​% receiving exercise therapy, 41.6 ​% physiotherapy, and 32.6 ​% manual therapy, while 54.0 ​% received none of these. Radiographs were obtained for 51.3 ​% and advanced imaging for 47.1 ​%. Arthroscopic surgery occurred in 18.9 ​% and arthroplasty in 0.2 ​%. Military patients received less pharmacological and more non-pharmacological treatment that non-military patients. Males had 1.5x the odds of surgery and higher pharmacological treatment use than females. Receipt of exercise therapy (adjusted OR ​= ​0.01; 95 ​% confidence interval 0.01, 0.02) significantly reduced the odds of arthroscopic surgery. Conclusion: Many patients received no interventions. For those receiving care, <50 ​% received guideline-recommended non-pharmacological care, including exercise therapy which significantly reduced the likelihood of surgery. Military patients had overall less pharmacological but more non-pharmacological treatment than non-military patients. A greater frequency of males had surgery. These findings indicate the need to further explore health care delivery for glenohumeral osteoarthritis in younger populations, highlighting potential guideline to practice gaps.